Dental anxiety and management of fear

Fear towards dental appointments is one of the main reasons why patients don’t seek treatment. Dental anxiety is the fifth most common cause of anxiety.

Most of this phobia is not realistic and it can be caused by a fear of pain during an appointment. With the growth of technology and dental education today, there is a lower expectancy for pain in patients.

Patients who have anxiety will be more sensitive toward any stimuli. These patients will experience more intense pain for a longer period of time. These patients generally will need more time to get their work done.

Dental anxiety will cause patients to avoid visiting a dentist which usually causes lower oral hygiene. More decay and gum disease can be found on these patients, who seek a dentist only when there is a dental emergency.These emergencies usually need more complicated treatments, which can have a more negative effect on them. On the other side if they see a dentist regularly, they are less likely to face these emergencies.

Dental anxiety can be caused by:

Previous unpleasant dental experiences especially as a child.

Learning from anxious family members.

Lack of understanding the procedures and consequences of not doing treatments on time.

Media portrayal of dentistry without proper information.

Fear of instruments, needles and blood.

Smell of dental material and even the noise of the instruments used.

Fear of unknown, especially if it is their first dental appointment.

Fear of chocking, gagging, or even radiation exposure.

Dentists needs to know:

Why the patient is seeking treatment

Patients’ expectations

Patients experience with previous dental treatments

How to reduce or eliminate dental anxiety:

The dental office environment should be welcoming. Receptionists, dental assistants, hygienists and any other staff member should be considerate of the situation. They should be trained to answer and explain every question that patients might have.

Communication and building trust is the main key to reduce the anxiety. If the dentist and the team are experts, trust will be gained very quickly.

Relaxation techniques such as meditation can be very helpful. For instance, focusing on breathing can calm the patient down. When patients are relaxed physically they will have less anxiety.

Manage the patients’ perspectives by showing and explaining what will be done. All the steps of the work can be explained for the first few sessions until the patient is fully aware of the treatment.

Distract the patient. This can be very beneficial for younger patients, especially kids. In some adults talking about things other than dentistry while working might help to distract them from overthinking.

If a patient’s anxiety can not be controlled by these steps, more professional help can be beneficial. For instance, counselling appointments may reduce the anxiety felt towards dental treatments. Dentists can also prescribe medications that can be used before the treatment to control the level of anexiety.

Dental anxiety can have negative effects on the patients’ life. This is our (dentists) duty to help the patients overcome their fear.

I am happy to announce that “Happy Smile Dental Clinic” has been extremely successful in achieving this goal. We are proud to make our clinic environment as comfortable as possible for every single patient.

Do you have a bad breath ( halitosis)?

What is Halitosis, or bad breath? Halitosis is a noticeable unpleasant smell, which is present when a person exhales . Halitosis is the third most common reason people meet with their dentists, right after tooth decay and gum disease. About 20% of people are reported to have concerns about halitosis up to some degree.

Not all people who think they have halitosis have a genuine problem when they are professionally examined. Of those who have genuine halitosis, often the smell is caused by bacteria present below the gumline and on the back of the tongue. .

There are several causes for bad breath. These can be from: 1-the respiratory system (Air way and sinus) 2-the digestive system ( stomach) 3-the oral cavity ( mouth)

What do we do when a patient comes to our office and has concern about bad breath?First step, we take a look at the patient’s breath. Does the patient breathe through their mouth or nose. If a patient is a mouth breather, the next step is to check the tonsils. In some occasions, the patient has a cold . Some patients have cryptic tonsils. This means that there are cave like spaces in the tonsils that will retain food particles secretions from the oral cavity. If the crypts are not clean, they can cause a bad smell. In this case, the patient will be recommended to gurgle mouth wash or salt water.

If the patient is a mouth breather but the tonsils are not large or cryptic, we will look for other options. Does the patient have any sinus problems? If yes, the patient needs to check with their family doctor. Next step, we check the mouth. All the soft tissues outside and inside the mouth will be checked. In some patients, the tongue will be the cause of the smell. Brushing the tongue will help to get rid of the smell but this tongue brushing needs to be done regularly. The reason for the smell from the tongue is a bacteria that grows on the tongue.

Next step, we will check the patient’s gums and teeth. Gum disease such as periodontitis can cause bad smell from the mouth. This can be diagnosed by a dentist. If a patient has deep decays that cause food impaction, they may also have bad breath. This can be addressed by a dentist. In case the patient has an infection in a tooth for a different reason, he/she may also experience bad breath.

If non of the above was found in a patient, we will ask about any possible stomach problems. Usually every person’s mouth will have a bad smell when they wake up. After eating food or drinking, the smell will go away.

In case the halitosis is from the gums and teeth, the dentist will take care of the problem. If there are other reasons, the family doctors can be in charge of it.

Rarely halitosis comes from a medical problem such as liver failure, however in the majority of cases, the cause is minor and can be reduced by instructions given by an expert.

What is a crown in dentistry?

A crown is a cap that is shaped like a tooth, which covers and restores the weak tooth structure.

When does a tooth need a crown?

When the tooth structure is extreemly weak and there is possibility to break. For instance when a tooth has root canal treatment or when a tooth has very large filling.

How many types of crowns do we have?

Crowns can be made of different materials.

In a full metal crown, the material can be gold or different type of metals.

Also there is porcelain fused to a metal ( PFM) crown, where the core of the crown is made from metal and the outer part of the crown is made out of porcelain. This way the crown looks like a natural tooth while the metal core supports the tooth.

In zirconia crown, the crown looks like a natural tooth and it is made only of zirconia.

There are other types of materials that can be used to make crowns, but the general idea is to cover the weak tooth structure to support the remaining mass. However, crowns can also improve tooth appearance.

The first step to make a crown is to:

1- Make an impression before doing anything to the tooth. This impression will be used to make a temporary crown and is called a preliminary impression.

2- The dentist will start reducing from all over the tooth structure, to make enough space to put the crown on. This reduction can vary in different parts of the tooth. For instance, the reduction on the biting side of the tooth should be slightly deeper to make a strong biting surface.

3- Taking an impression from the prepared tooth. This impression is called the final impression.

4- Final impressions will be sent to the laboratory with detailed instructions for the crown to be made.

5- Temporary crowns will be made from the preliminary impressions (first impression), and they will be cemented in place.

6- When the permanent crown is made, it will be cemented with permanent cement in place. This step will be done after removing the temporary crown and polishing the tooth to make sure there is no temporary cement left on the tooth. Also before cementing, we will make sure that the crown fits well and that the contacts and the bite is correct.

Dr. Roushanak Shafaghi

What is inside your tooth?

You can only see one part of your whole tooth, which is called the crown. The crown is attached to root that is placed in the jaw bone. Some teeth have more than one root, such as the teeth in the back (molars have more than one root).

What is the structure of your tooth? Every single tooth has the outer layer (covering the crown), that we can see and we call it ENAMEL. Enamel is the hardest part of a human body, even harder than bone. However enamel is brittle, which means that if you use your teeth to bite on hard things it may chip off.

The second layer of a tooth is called DENTIN. We can not usually see dentin because it is covered with enamel.

The third layer of a tooth is called PULP.

What is inside the Pulp? The pulp is composed of 75% water and 25% is other material, such as:

1- Vessels that brings blood to and from the tooth. 2- Nerves that allow us to feel pain if the tooth is broken or if we have decay. 3- Many different cells that help the function of the tooth.

Pulp extends from the crown part of the tooth into the roots like a pipe. This pipe allows the blood supply and nerves to go into the tooth.

As we get older the pulp shrinks and becomes smaller. This means that the dentin layer becomes thicker. That is why if younger children have deep decay there is more possibility to need a root canal treatment than older people. This means that the decay reaches the pulp faster in younger people because the pulp is bigger and dentin is thinner. In older people there is a thicker layer of dentin so decays needs to be larger to reach the pulp.

What is Fissure sealant?

It is a plastic coat that is put on the grooves and pits of the back teeth to prevent decay on the surface.

Why do patients need Fissure sealant?

Fissure sealant will prevent tooth decay on the surface of the tooth up to 85% of the time.

Who is a candidate for fissure sealant?

patients with low caries risk can be candidates for fissure sealants. This means that if the patient has many active cavities, they will not be a candidate, because active cavities grow very fast.

Who is not a candidate for Fissure sealant?

Patients that are high risk for decay are not good candidates for Fissure sealants. If fissure sealant is applied in this case, there might be decay underneath the sealant and it will be hidden from the dentist.

Can both primary and permanent teeth have fissure sealant?

yes, dentists can apply fissure sealants for both baby teeth and permanent teeth.

Patient’s in BC need to know that dentalinsurances will not payfor fissure sealants on primary teeth. If parents are willing to get this treatment done for primary teeth, they can talk with their dentist.

Is there any age limit for Fissure sealant? This treatment will be more beneficial for patients up to 15 years of age.

How is fissure sealant done?

The tooth needs to be dry and isolated from saliva.

A gel will be applied to the tooth and after 20 seconds will be rinsed and dried

The fissure sealant material will be applied to the grooves and pits of the tooth.

A blue light will be used to make the material hard

The bite will be checked to make sure it is not interfering with the patients bite.

Dental Decay in children and importance of Dental Visits

Now a days parents are more aware of their children’s oral health. This brings more children to dental practices. I as a general dentist am very happy about this awareness. It is extremely important to take care of the primary (baby) teeth and I will let you know some of the important reasons.

1-kids eat better when they have healthy teeth. When children have decay (cavities) they will have pain when eating cold and sweet foods. If the decay is very extensive, they might avoid eating at some point because of the discomfort.

2- Kids will be happier when they have good oral health. Even very young children can see if they have decay on their teeth that doesn’t look good. They might ask their parents about the brown spot on their teeth.

3- When children have decay and pain, they will be in a bad mood and many times, parents won’t know why the child is acting differently.

4- Kids several painful decay might have digestive problems. This will be due to not chewing the food properly or not eating proper food. For instance, they might not be able to chew harder foods, which is a really important part of a healthy digestion.

5- Baby teeth work as space maintainers. They keep the space available for the permanent teeth to come in place. Losing a baby tooth will slow down the permanent tooth coming out on time, because now they don’t have a guidance. Delay in the tooth coming out might cause space closure (adjacent teeth will move into the space) and crowding. Then, it becomes possible to trap the permanent tooth.

6-Children who have dental decays and lose their teeth earlier than expected are more likely in need of orthodontic treatments.

What can parents do:

1- It is recommended that parents start their child’s dental check ups since the first tooth comes out. Your dentist will give you oral hygiene instructions to keep the teeth healthy.

2- Always be aware of the number of times your child is eating sweet foods. Lower the number of times teeth are attacked by sweet foods to a maximum of twice daily.

3- Make sure your child will get to the habit of brushing every night before going to bed. The best way to create this habit is to do it as a whole family.

4- Take your child for recall exams every six months. In case there is a decay (cavity) it will be taken care of before it is too late.

Some healthy snacks for your kids:

1- Vegetables and fruits.

2-Nuts if your child is not allergic.

3- Cheese, mostly children like cheese string or baby bell cheese.

4- Home made juice is ok but I do not recommend any juice bought. I have seen the worst dental decays on kids who regularly drink juice.

Gum disease can expand to not only the mucosal area that covers the tooth bearing area, but also to all of the tooth supporting areas, including bone that is surrounding the roots.

In General there are two types of gum disease.

1- Gingivitis

2-Periodontitis

Gingivitis:

Is the most common form of gum disease, but is reversible. In gingivitis there is inflammation in the gum (infection in the mucosal area surrounding the teeth)

There can be several reasons for gingivitis. The main reason is plaque around and under the gums. Plaque is full of bacteria that can cause inflammation in the gum.

Gingivitis in its first stages can be treated with proper oral hygiene. Ten days of accurate brushing and flossing can treat early stage gingivitis.

Periodontitis:

Is an inflammatory disease of the tooth supporting tissues.This is caused by some destructive micro-organisms. One of the main causes for periodontitis is un-treated gingivitis.

What happens in periodontitis: Untreated gingivitis means that there are lots of bacteria around the gum. They have not been cleaned and removed, hence, the infection will move to the bone surrounding the roots. Now there is infection in the bone. This infection will cause bone resorption. Bone loss will be continued if periodontitis is not treated. When the bone is resorbed, it will not come back with treatment but the resorption can be stopped.

Main treatment for periodontitis is Scaling (cleaning professionally with your dentist or Hygienist) to remove all the deposits and plaque around and under the Gum.

Your dentist might decide to prescribe you a special mouth wash during the treatment. Also your dentist may advise you to get your cleaning done every 3 or 4 months until the condition is under control. If the periodontitis is under control, you need to keep your cleaning appointments for every 6 months.

You should know that when you have periodontitis, you need to get your cleaning done regularly and consistently.

THE REASON YOU NEED TO GET YOUR CLEANING DONE EVERY 6 MONTHS:

after around 6 months, infection in your gum can move to the bone, and removing the source of infection every 6 months will lower the chance of periodontitis.

There are other causes for gingivitis and periodontitis which include hormonal changes, genetics, viral infections, immune system disease, smoking, some medications, malnutrition, fungal infections, systemic disease such as allergic reactions, and so on.

Last but not least, this article is providing general information for the public, but it is important to know that this is a broad and deep topic and that there is yet much to be covered about gingivitis and periodontitis.

Do you have shorter front teeth with sharper edges compared to a few years ago?

Do you have flat teeth (no cusps anymore) on your Molars and premolars (back teeth)?

These can be signs of grinding and clinching.

Bruxism means: Excessive teeth grinding. There are two types of Bruxism. One type happens during sleep. The other one happens when the person is awake.

Clinching means: Pushing teeth hardy against each other. This is like biting very hard for a long time.

The majority of bruxism is caused by stress and anxiety.

There are different ways to prevent this destructive routine.Below you can find two ways that your dentist can help you:

1- You can wear Night Guard to prevent removing more tooth structure. So basically when you use a Night Guard you grind the night guard and not your teeth. However, night guards will not stop your grinding.

2- Injecting Botox in a specific area that is responsible for chewing (masseter muscle) can slow down the grinding and clinching and its destructive action.

Some information about botox:

A) Botox is injected with very thin needles( insulin needles)

B) Botox injection doesn’t hurt much

C) Effect of botox injection can be seen 3 to 10 days after injection

D) Results of botox injections may stay up to 4 months, then re-treatment is needed

E) By repeating the injections the results will likely last longer

F) Botox effects are not permanent, and there are no permanent side effects

Injecting botox to the masseter muscle will stop the grinding and clinching while it is effective. The injections need to be repeated when the effect is gone.

Do you have sensitivity after dental cleaning?

Recession means: The exposure of the roots, caused by losing gum tissue.

Recession, roots are exposed

These are a few causes of sensitivity after dental cleaning:

You have recession and deposits around the roots: these deposits cover the roots and prevent them from the cold. When they are removed, the roots become naked and feel cold. Now the roots are exposed to the oral cavity and there is no more coating around them. This is a normal feeling and it will subside after time. Also dentists can apply different material to limit or stop the sensitivity. Please communicate with your dentist for your options.

Recession with deposit. Part of root on that single tooth is exposed and there is deposit around the gum line. The gum is red.

Patients should also know that deposits are full of bacteria and that they are the number one reason for gum disease. This is why patients need to get their cleaning (scaling) done regularly.

You have recession and not bulks of deposits: the mechanical removal of deposit can irritate the dental tubes and cause sensitivity . This sensitivity will subside after a few days. Also your dentist can apply material to reduce the sensitivity.

The lower teeth have recession but no deposits. Three roots are exposed.

You have healthy gums and no recession: It is very unlikely to have sensitivity on non receded teeth, but it is possible. In this case, time will solve the sensitivity. Also your dentist can apply material that will help the sensitivity.

Healthy gums are light pink and hard.

You haven’t been flossing regularly: If you don’t have the habit of flossing regularly or your oral hygiene is poor, you might feel sensitivity after cleaning.When the oral hygiene is not good, there will be lots of bacteria in the plaque and deposits around the teeth.This will cause inflammation around the gums. When cleaning and removing the plaque and deposits, your gum becomes irritated and sensitive. Time and regular hygiene will subside the sensitivity.

Unhealthy gums due to poor oral hygiene. Gums are red and they bleed when brushing and flossing.

How to minimize having sensitivity after dental cleaning:

Have good oral hygiene and do proper and regular brushing and flossing

Get your cleaning done regularly. Patients who get their cleaning done regularly experience less sensitivity after cleaning.

Do you have tooth sensitivity?

There are several reasons that you might have sensitivity.

Tooth decay

Gum disease

Clinching and grinding

Erosion and abrasion

After restorations

Tooth Decay

If you have cavities, you will feel pain when you eat sweet and cold foods. In some cases patient will have pain with hot foods.If the pain is momentary after cold or sweet foods, most likely there is tooth decay. If the sensitivity comes after eating hot foods and if it lasts for more than 10 seconds and becomes painful, it means that the decay is very deep and that you might need immediate attention from your dentist.

Gum disease

In case of a gum problem, the colour of your gum might change from light pink to red and sometimes purplish red. You need to clean your teeth meticulously by brushing and flossing to remove any plaque present around your gum lines. Plaque is full of bacteria, and bacteria will cause infections around you gums.Then, your gums become inflamed and will bleed while brushing. By removing the plaque you should feel less sensitivity.

Clinching and grinding

Do you have sore muscles and sensitive teeth when you wake up in the morning? you need to check with your dentist for possible solutions. Having a night guard to use at nigh time can prevent the damage to your teeth. Botox injections can be an alternative treatment for heavy grinders.

Erosion

Erosion happens when you eat sour foods for a long time. The acid in the food dissolves the calcium in your enamel. Consequently enamel becomes thinner and thinner until it is all gone. When dentin (the second layer of the tooth) is exposed to oral cavity, you will feel sensitivity. Avoid sour foods and check with your dentist for treatment options.

Abrasion

Abrasion happens when you brush your teeth aggressively or the wrong way. In abrasion, the patient removes the enamel by physically removing it. Exposed dentin will then cause sensitivity. So check your brushing habits and make sure you use a soft tooth brush.

After restorations

After a filling is done, patients can experience sensitivity. Removing decay from your teeth is like doing a small surgery. Teeth have nerves and a blood supply. After cleaning the cavities, sometimes the nerves get irritated and cause sensitivity. Make sure you check with your dentist to check your bite. In some occasions even the slightest extra filling material can cause sensitivity. In this situation after adjusting the bite, the patient will feel relived right away. The best thing is to check with your dentist as soon as you feel sensitive after a restoration.